Question

Case Study #1a: Respiratory System

Mrs. Breathless is a 43-year-old female, just getting off the late shift. She reports to the ER in the early morning with shortness of breath. She has cyanosis of the lips. She has had a productive cough for 2 weeks. Her temperature is 102.2, blood pressure 110/76, heart rate 108, respiration 32, rapid and shallow. Breath sounds are diminished in both bases, with coarse rhonchi in the upper lobes. Chest X-ray indicates bilateral pneumonia.

• ABG (Arterial Blood Gases) Lab results are:           
  • pH= 7.44
  • PaCO2= 28
  • HCO3= 24
  • PaO2= 54

Note: rhonchi are continuous low pitched rattling lung sounds that often resemble snoring or wheezes.

Problems:

• PaCO2 is low.
• pH is on the high side of normal, therefore compensated respiratory alkalosis.
• Also, PaO2 is low, probably due to mucous displacing air in the alveoli affected by the pneumonia.

Discussion Questions Case Study #1a:

1. Explain what ARDS is.
2. Explain what is significant with her lab results using the ABG normal values and the nursing mnemonic ROME which I have included.
3. Explain why the solution or treatment is appropriate.

Answer 1

ARDS is Acute Respiratory Distress Syndrome. The fluid is leak into the alveoli sac leads to less supply of oxygen to the body causing breathlessness. Severe cough, shortness of breath, high fever, rapid breathing, and fast heartbeat are symptoms of ARDS.

ROME(ABG interpretation)

Respiratory Opposite

Metabolic Equal

pH - 7.44 normal (on alkaline side.)

pCO2 - 28 Low

HCO3 - 22 normal.

Hence the arrow(pH & pCO2) is opposite, but pH is normal because of compensated. Hence it is called Compensated respiratory alkalosis. Hyperventilation of patients to meet oxygen demands results in respiratory alkalosis.

Supplemental oxygen delivery is necessary to compensate the oxygen requirement. Fluid restriction to minimize the fluid build up in the lungs. Treat of an underlying cause to prevent complications. Mechanical ventilation to force the air into the alveoli and to get out of fluids. The reassurance of the client and the relieve of anxiety helps for quick recovery.